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                   No Misunderstanding
          
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A Sacramento health plan under fire for its marketing practices in San
Francisco has agreed to cut back on its door-to-door sales to
low-income clients, but not enough to appease its critics in San
Francisco City Hall.
   
At a hearing Tuesday before the Board of Supervisors' Health, Public
Safety and Environment committee, low-income residents testified that
they fell for sales pitches from Foundation Health, a health
maintenance organization, and did not realize they could not be
treated by doctors and hospitals they had used.
   
Among those testifying was My Hanh Truong, who signed away her right
to visit city clinics when she joined the Foundation HMO. She said
terms of the deal were explained to her by her 14-year-old child, who
served as a Vietnamese interpreter when the Foundation marketer
visited her home.
   
Foundation executives agreed at the hearing to immediately halt
door-to-door marketing in cases in which the salesperson does not
speak the language of the prospective client. But the HMO officials
resisted pressure by Supervisor Susan Leal, who had called for the
hearing, to halt door-to-door sales until at least April 1.
   
Leal said there is something inherently wrong with health insurers
using door-to-door sales tactics to sign up patients who are eligible
for Medi-Cal, the joint state and federal health insurance program for
the poor. "Complicated concepts like managed care are not being
explained by a neutral party, but by salespeople going door-to- door,
being paid by the number of people they enroll."
   
Leal wanted Foundation to temporarily halt the practice until a
state-run program called Health Care Options is put in place in San
Francisco. That program uses state employees to explain to welfare
recipients what options are available under the Medi-Cal program.
   
But Supervisor Angela Alioto questioned whether it was necessary to
stop the door-to-door program. "Any kind of hindrance to competition
is not something I take lightly," she said. "If there is wrongdoing,
there are state authorities who can reprimand."
   
Witnesses on Tuesday suggested that the Foundation marketing program
has sown confusion among many Medi-Cal recipients. Nora Rogan, a nurse
at San Francisco General Hospital, said the city medical center has
registered 433 instances in which patients had gone there to be
treated, only to find out that because they had signed up with the
Foundation plan, they could be treated only at nearby St. Luke's
Hospital.
   
Rogan indicated that the patients could not be blamed for the mix-ups.
"They asked, `Can I still go to see my doctor,' and the marketers
said, `Yes,'" she testified. "I don't think that can be called a
`misunderstanding.'"
   
Foundation Health vice president Matt Lonsdale told the panel that the
sales practices his company uses "have long been approved by the state
Department of Health Services, which regulates the business we are
in." To ensure that new enrollees understand the contracts, Lonsdale
said, they are read carefully scripted explanations, and their
responses are also recorded on tape.

(HMO Agrees to Change Its Sales Tactics Somewhat, Sabin Russell,
San Francisco Chronicle, 1/26/95)

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